2013-10-15T17:19:52-05:00 2012-12-31 910189318 MOSS ADAMS LLP PO BOX 22650 YAKIMA WA 989072650 990 2012-01-01 840446259 VALLEY VIEW HOSPITAL ASSOCIATION VALL 9709456535 PO BOX 1970 GLENWOOD SPRINGS CO 816021970 LARRY DUPPER 9709456535 2013-10-16 1 CHRISTOPHER E RIVARD P00022321 5092487750 2012 2016-02-25 16:41:14Z GARY BREWER 1906 BLAKE AVE GLENWOOD SPRINGS CO 81601 238218396 0 X WWW.VVH.ORG X 1950 CO VALLEY VIEW HOSPITAL IS AN ACUTE CARE HOSPITAL OWNED BY VALLEY VIEW HOSPITAL ASSOCIATION, INC., A NOT-FOR-PROFIT CORPORATION. THE HOSPITAL PRIMARILY EARNS REVENUE BY PROVIDING INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO PATIENTS IN GLENWOOD SPRINGS, COLORADO. 9 6 1045 300 8679 7277 366859 187133 158794946 165252313 3080931 3245463 -260123 -218553 161982613 168466356 7500 2500 0 0 68251188 76941803 12500 0 0 60649429 67169568 128920617 144113871 33061996 24352485 314465137 332478058 141424307 135269696 173040830 197208362 X TO BE THE LEADER FOR EXCELLENCE IN PERSONALIZED CARE AND HEALING. 1 0 26776649 45126477 OPERATING ROOM - TOTAL SURGICAL VISITS OF 3,486.VALLEY VIEW HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, AGE, CREED, SEX, NATIONAL ORIGIN, OR HANDICAP. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF VALLEY VIEW HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND, FURTHER, THAT OUR MISSION IS TO PROVIDE ACUTE HEALTHCARE SERVICES TO OUR COMMUNITY. THEREFORE IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. 15086923 25425873 PHARMACY - TOTAL PATIENT DAYS OF 10,849VALLEY VIEW HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, AGE, CREED, SEX, NATIONAL ORIGIN, OR HANDICAP. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF VALLEY VIEW HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND, FURTHER, THAT OUR MISSION IS TO PROVIDE ACUTE HEALTHCARE SERVICES TO OUR COMMUNITY. THEREFORE IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. 11343114 19116461 LAB - TOTAL PATIENT DAYS OF 10,849.VALLEY VIEW HOSPITAL PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, AGE, CREED, SEX, NATIONAL ORIGIN, OR HANDICAP. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF VALLEY VIEW HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND, FURTHER, THAT OUR MISSION IS TO PROVIDE ACUTE HEALTHCARE SERVICES TO OUR COMMUNITY. THEREFORE IN KEEPING WITH THE HOSPITAL'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE; CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST; AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY WILL BE CONSIDERED WHERE THE NEED AND/OR INDIVIDUAL'S INABILITY TO PAY CO-EXISTS. THESE ACTIVITIES INCLUDE WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, AND SPECIAL PROGRAMS FOR THE ELDERLY, HANDICAPPED, MEDICALLY UNDERSERVED, AND A VARIETY OF COMMUNITY SUPPORT ACTIVITIES. 56479678 2500 73242642 THE HOSPITAL ALSO OPERATES AN EMERGENCY ROOM, ACUTE CARE, FAMILY BIRTH PLACE, RADIOLOGY, CARDIOLOGY, CRITICAL CARE, AND OTHER PROGRAM SERVICES. 56479678 2500 73242642 109686364 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 1 102 0 1 1045 1 1 1 0 0 0 0 0 0 0 0 0 X 9 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 CO X THE ORGANIZATION 9709456535 PO BOX 1970 GLENWOOD SPRINGS CO 816021970 MIKE FATTOR 1.00 X X 0 0 0 JEFF CARLSON 1.00 X X 0 0 0 STEVE VANDERHOOF 1.00 X X 0 0 0 LOUIS MEYER 1.00 X X 0 0 0 PAUL SALMEN MD 1.00 X 0 0 0 MATT GOODSTEIN MD 1.00 X 0 0 0 MARIANNE VIRGILI 1.00 X 0 0 0 ROBERT DERKASH MD 1.00 X 0 0 0 LYNN KLEAGER 1.00 X 0 0 0 GARY BREWER 40.00 X 987643 0 23246 LARRY DUPPER 40.00 X 535052 0 23311 DEB WIEPKING 40.00 X 399644 0 23078 FRANK LAWS MD 40.00 X 803113 0 23358 DAVID MILLER MD 40.00 X 997563 0 23357 CLAUDIO FELER MD 40.00 X 931389 0 6577 JOHN GEORGE MD 40.00 X 722875 0 23358 BRUCE GREENE MD 40.00 X 583577 0 1485 5960856 0 147770 95 0 1 0 ROARING FORK FAMILY PHYSICIANS PC 1340 HIGHWAY 133 CARBONDALE CO 81623 PROFESSIONAL SERVICES 399781 ADELMANSHEFF & SMITH LLC 180 ADMIRAL COCHRANE DR STE 370 ANNAPOLIS MD 21401 LEGAL SERVICES 339306 GLENWOOD MEDICAL ASSOCIATES PC 1830 BLAKE AVE GLENWOOD SPRINGS CO 81601 PROFESSIONAL SERVICES 337685 THOMAS G MORTON MD 1487 COUNTY ROAD 117 GLENWOOD SPRINGS CO 81601 FAMILY PHYSICIAN 293158 ROARING FORK SURGICAL ASSOC PC 180 BLAKE AVE STE 202 GLENWOOD SPRINGS CO 81601 PROFESSIONAL SERVICES 267000 13 34000 153133 187133 PATIENT SERVICES REVEN 621400 162459075 162459075 MEDICAL/PHARMACY/MISCELLANEOUS 561499 1322706 1322706 CATERING/CAFETERIA 722320 1009475 1009475 HEALTHCARE MANAGEMENT 561499 195792 187113 8679 CHILD CARE 624410 176149 176149 89116 89116 165252313 2952136 2952136 1011459 1230012 -218553 -218553 -218553 68600934 214421 68522028 0 78906 214421 293327 293327 168466356 162911453 8679 5359091 2500 2500 1991974 1991974 55211792 44092021 11119771 2383106 1955887 427219 13905813 11084381 2821432 3449118 2749306 699812 329965 329965 229529 229529 11517 11517 23615 23615 12864156 5319354 7544802 129870 22542 107328 15075807 14119968 955839 1548382 1548382 2822558 2314498 508060 61260 55328 5932 415157 272366 142791 5225228 5225228 10639505 8937184 1702321 1138048 611475 526573 UBIT TAXES 44000 44000 BAD DEBT EXPENSE 6959995 6959995 MEDICAID PROVIDER FEES 6338000 6338000 MEDICAL SPECIALIST FEES 3303177 3303177 9799 9799 144113871 109686364 34427507 0 42151953 31650027 16819670 20138376 2996804 2920784 935248 1258604 252846207 77762834 149636266 175083373 101925196 101426894 314465137 332478058 23070877 18269281 113649164 111494975 4704266 5505440 141424307 135269696 X 172327631 196612192 713199 596170 173040830 197208362 314465137 332478058 X 24352485 -76684 -108269 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 11517 11517 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: PORTION OF ANNUAL DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND COLORADO HEALTH & HOSPITAL ASSOCIATION WERE USED FOR LOBBYING PURPOSES. 5640265 1423992 7064257 19313301 171242106 48757996 141797411 50427955 29004838 21423117 4798588 4798588 175083373 BOND ISSUANCE COSTS, NET 1154879 INTEREST RECEIVABLE 606268 INVESTMENT IN EAGLE HEALTH CARE CENTER, INC. 7545733 OTHER SECURITIES 92120014 101426894 ACCRUED COMPENSATION RELATED TAXES 4434711 ESTIMATED MALPRACTICE COSTS 1070729 5505440 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND A SIMILAR PROVISION OF STATE LAW. HOWEVER, THE ORGANIZATION IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. THE HOSPITAL ADOPTED THE INCOME TAX STANDARD RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE INCOME TAX STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2012. 1 1 1 X 0.000000000000 1 X 500.000000000000 1 1 1 0 1 1 6235003 6235003 0.04550 25719507 11447155 14272352 0.10410 3025338 529654 2495684 0.01820 34979848 11976809 23003039 0.16780 545604 240004 305600 0.00220 18300 18300 0.00010 563904 240004 323900 0.00230 35543752 12216813 23326939 0.17010 8560000 1430000 7130000 0.05200 1604000 910000 694000 0.00510 3840 3840 0.00000 10167840 2340000 7827840 0.05710 1 3308782 2713201 19085833 26655158 -7569325 X 1 1 1 1 VALLEY VIEW HOSPITAL ASSOCIATION

1906 BLAKE AVE GLENWOOD SPRINGS CO 81601

WWW.VVH.ORG X X X SOLE COMMUNITY HOSPITAL VALLEY VIEW HOSPITAL ASSOCIATION 1 1 X X X X X X X X 12 1 0 1 X X X X X X X X 0 0 1 1 1 500.000000000000 1 X X X 1 1 X X X X X X 1 0 1 X 0 0 PART I, L7 COL(F): THE HOSPITAL USED A COST TO CHARGES METHODOLOGY IN DERIVING BAD DEBT EXPENSE(AT COST)ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITAL'S CHARITY CARE POLICY. ANALYSIS WAS DONE ON RANDOMLY SELECTED ACCOUNTS WRITTEN OFF TO BAD DEBT. IN APPROX. 88% OF ACCOUNTS TESTED, PATIENTS WOULD HAVE QUALIFIED FOR CHARITY CARE BUT REFUSED TO PROVIDE INFORMATION AND DOCUMENTATION FOR CHARITY ASSESSMENT, THEREFORE WAS INCLUDED IN BAD DEBT. PART I, LINE 6A: THE ANNUAL COMMUNITY BENEFIT REPORT IS AVAILABLE TO THE PUBLIC UPON REQUEST AND ON THE HOSPITAL'S WEBSITE. PART II: 2. THE HOSPITAL CREATES NEW EMPLOYMENT OPPORTUNITIES IN AREAS WITH HIGH RATES OF JOBLESSNESS3. THE HOSPITAL PROVIDES MENTORING PROGRAMS FOR TROUBLED TEENS IN THE COMMUNITY6. AS A MEMBER OF A LARGER ALLIANCE, THE HOSPITAL PARTICIPATES IN COLLABORATIVE EFFORTS WITH THE COMMUNITY TO ADDRESS HEALTH AND SAFETY ISSUES PART III, LINE 4: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FORDOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS INCREASED FROM 83 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011, TO 84 PERCENT OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2012. HOSPITAL'S SELF-PAY WRITEOFFS INCREASED FROM $1,743,949 FOR FISCAL YEAR 2011 TO $1,877,474 FOR FISCAL YEAR 2012. THE HOSPITAL HAS NOT CHANGED ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING THE FISCAL YEARS 2012 AND 2011.THE HOSPITAL USED A COST TO CHARGES METHODOLOGY IN DERIVING BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE HOSPITALS CHARITY CARE POLICY. ANALYSIS WERE DONE ON RANDOMLY SELECTED ACCOUNTS WRITTEN OFF TO BAD DEBT. IN APPROXIMATELY 88% OF ACCOUNTS TESTED, PATIENTS WOULD HAVE QUALIFIED FOR CHARITY CARE BUT REFUSED TO PROVIDE INFORMATION AND DOCUMENTATION FOR CHARITY ASSESSMENT, THEREFORE WERE INCLUDED IN BAD DEBT. PART III, LINE 8: VALLEY VIEW HOSPITAL IS THE HOSPITAL OF CHOICE FOR THE ELDERLY POPULATION BECAUSE MEDICAL STAFF IN THE SURROUNDING AREA RESISTS TAKING CARE OF THIS POPULATION.THE HOSPITAL USED A COST TO CHARGES METHODOLOGY IN DERIVING MEDICARE ALLOWABLE COSTS. PART III, LINE 9B: THE HOSPITAL PROVIDES CARE WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES TO PATIENTS MEETING CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. VALLEY VIEW HOSPITAL ASSOCIATION PART V, SECTION B, LINE 3: VALLEY VIEW HOSPITAL PRESENTED THE COMMUNITY HEALTH NEEDS ASSESSMENT TO REPRESENTATIVES OF THE COMMUNITY. THE IDENTITY OF THE PERSONS CONSULTED CONSISTED OF MEMBERS OF THE CHAMBER OF COMMERCE, LOCAL PHYSICIANS, COMMUNITY LEADERS, AND BUSINESS OWNERS. VALLEY VIEW HOSPITAL ASSOCIATION PART V, SECTION B, LINE 7: SOME LOWER PRIORITY HEALTH NEEDS IDENTIFIED, SUCH AS UNTREATED TOOTH DECAY IN THIRD GRADERS, HAS NOT BEEN ADDRESSED DUE TO LACK OF RESOURCES. VALLEY VIEW HOSPITAL ASSOCIATION PART V, SECTION B, LINE 20D: THE HOSPITAL USES FPG TO DETERMINE THE AMOUNT OF DISCOUNT UP TO 95% TO BE DEDUCTED FROM GROSS CHARGES. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES THROUGH SURVEYS TAKEN BY COMMUNITY HEALTH DEPARTMENTS AND INPUT FROM COMMUNITY FOCUS GROUPS. PART VI, LINE 3: THE HOSPITAL EMPLOYS CONSULTING GROUPS ON A FULL-TIME BASIS TO ASSIST PATIENTS IN COMPLETING FORMS THAT DETERMINE THEIR ELIGIBILITY FOR ATTAINING FINANCIAL ASSISTANCE. PART VI, LINE 4: THE HOSPITAL SERVES A RESORT COMMUNITY WITH GEOGRAPHIC CHALLENGES MAKING TRAVEL DIFFICULT AT TIMES, IN ADDITION TO BEING CHALLENGED BY THE NUMEROUS VISITORS THAT COME TO THE VALLEY. X 0 1 X X X X 0 1 0 0 0 0 0 0 0 GARY BREWER 561123 0 426520 0 0 0 20860 0 2386 0 1010889 0 0 0 LARRY DUPPER 282603 0 252449 0 0 0 20860 0 2451 0 558363 0 0 0 DEB WIEPKING 234229 0 165415 0 0 0 20860 0 2218 0 422722 0 0 0 FRANK LAWS MD 744595 0 58518 0 0 0 20860 0 2498 0 826471 0 0 0 DAVID MILLER MD 873563 0 124000 0 0 0 20860 0 2498 0 1020921 0 0 0 CLAUDIO FELER MD 794989 0 136400 0 0 0 4080 0 2498 0 937967 0 0 0 JOHN GEORGE MD 646186 0 76689 0 0 0 20860 0 2498 0 746233 0 0 0 BRUCE GREENE MD 507971 0 75606 0 0 0 0 0 1485 0 585062 0 0 0 PART I, LINE 1A CHRISTMAS GIFTS GIVEN TO UPPER MANAGEMENT INCLUDING LARRY DUPPER AND DEB WIEPKING. PART I, LINE 1B THE CEO DETERMINED CHRISTMAS GIFTS OF $250 WOULD BE GIVEN TO EACH PERSON OF UPPER MANAGEMENT. A GARFIELD COUNTY COLORADO 840594277 36565PAB1 2003-05-01 44764767 SEE SCHEDULE O 0 0 0 B COLORADO HEALTH FACILITIES AUTHORITY 840752932 1964742X7 2006-05-01 30359232 SEE SCHEDULE O 0 0 0 C COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AFQ3 2007-10-18 44445997 SEE SCHEDULE O 0 0 0 D COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AHR9 2008-05-06 50516309 SEE SCHEDULE O 0 0 0 A 45869480 3322564 17265000 1284705 23972517 2007 0 0 1 1 B 30056630 2575729 332724 27161687 2008 0 0 1 1 C 47988053 4422563 563072 43001229 2012 0 0 1 1 D 50662927 5118506 45000000 544422 2008 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 1 0 D 0 0 0 0 0 0 0 0 0 A 0 B 0 C 0 D 0 FORM 990, SCHEDULE K, PART II, LINE 3 ISSUE PRICE AND TOTAL PROCEEDS OF ISSUE ARE DIFFERENT DUE TO INVESTMENT EARNINGS AND LOSSES. MATT GOODSTEIN MD TRUSTEE 56532 RENT PAID TO VVH FOR OFFICE SPACE 0 PAUL SALMEN MD TRUSTEE 34950 SERVICES RENDERED TO VVH AS DIRECTOR OF YRC 0 PAUL SALMEN MD TRUSTEE 274814 PHYSICIAN FEES PAID BY VVH TO GMA 0 PAUL SALMEN MD TRUSTEE 536860 NET RENT RECEIVED BY VVH FROM GMA FOR OFFICE SPACE 0 ROBERT DERKASH MD TRUSTEE 154808 RENT RECEIVED BY VVH FROM ORTHOPAEDIC ASSOCIATES OF ASPEN AND GLENWOOD FOR OFFICE SPACE. 0 PAUL SALMEN MD TRUSTEE 17135 SERVICES RENDERED TO VVH IN THE PSYCHIATRY DEPARTMENT 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 VALLEY VIEW HOSPITAL'S CANCER CENTER OPENED FOR BUSINESS IN OCTOBER 2012 FORM 990, PART VI, SECTION A, LINE 2 TRUSTEE FORM 990, PART VI, SECTION A, LINE 6 THERE ARE TWO CLASSES OF MEMBERS, CHARTER OR LIFE MEMBERS AND ANNUAL MEMBERS. THOSE PERSONS OR ENTITIES WHO ARE CHARTER OR LIFE MEMBERS AS OF 7/31/95, WILL CONTINUE TO BE LIFE MEMBERS. PERSONS WHO BECOME MEMBERS OF THE ASSOCIATION AFTER 7/31/95, SHALL PAY AN ANNUAL MEMBERSHIP FEE OF $25. EACH MEMBER IN GOOD STANDING SHALL HAVE ONE VOTE IN THE BUSINESS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A EACH MEMBER OF THE CORPORATION IN GOOD STANDING SHALL BE QUALIFIED TO VOTE ON ELECTION OF BOARD MEMBERS AND THE DISPOSITION OF ASSETS AND TO HOLD ANY OFFICE IN THE CORPORATION TO WHICH HE MAY BE ELECTED OR APPOINTED. MEMBERS OF THE CORPORATION SHALL BE ELECTED TO THE BOARD OF TRUSTEES OF THE CORPORATION AS APPROPRIATE AT EACH ANNUAL MEETING OF THE CORPORATION. THE BOARD OF TRUSTEES SHALL CONSIST OF NINE ELECTED MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE ADMINISTRATIVE POWERS OF THE VALLEY VIEW HOSPITAL ASSOCIATION SHALL BE VESTED IN THE BOARD OF TRUSTEES, WHO SHALL HAVE CHARGE OF THE MANAGEMENT AFFAIRS, FUNDS AND PROPERTY OF THE HOSPITAL, AND WHO SHALL HAVE THE AUTHORITY TO PERFORM ALL ACTS AND FUNCTIONS NOT INCONSISTENT WITH THE BYLAWS OR WITH ANY ACTION TAKEN BY MEMBERS OF THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 INFORMATION FOR SCHEDULES COMPILED BY THE ASSISTANT CONTROLLER AND CONTROLLER, SUBMITTED TO INDEPENDENT AUDITORS TO ASSEMBLE INTO FORM 990 AND 990T, AND REVIEWED BY THE CFO AND BOD BEFORE BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE OF INTEREST STATEMENT, DISCLOSING ANY INTERESTS WHICH MAY GIVE RISE TO A CONFLICT OF INTEREST OR THE APPEARANCE OF A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: INCLUDED BUT NOT LIMITED TO COMPARABILITY DATA FROM 2011/2012 WATSON WYATT DATA SERVICES "SURVEY REPORT ON HOSPITAL AND HEALTHCARE MANAGEMENT COMPENSATION", 2012 EXECUTIVE COMPENSATION SURVEY FOR COLORADO SMALL AND RURAL HOSPITALS INCLUDING CRITICAL ACCESS HOSPITALS DATA, AND IS REVIEWED AND APPROVED BY THE BODS. FORM 990, PART VI, SECTION B, LINE 15B: INCLUDED BUT NOT LIMITED TO COMPARABILITY DATA FROM 2011/2012 WATSON WYATT DATA SERVICES "SURVEY REPORT ON HOSPITAL AND HEALTHCARE MANAGEMENT COMPENSATION", 2011/2012 COLORADO HOSPITAL ASSOCIATION SURVEY, 2011/2012 MOUNTAIN STATES EMPLOYER'S COUNCIL SURVEY, AND IS REVIEWED AND APPROVED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 18 UPON REQUEST FORM 990, PART VI, SECTION C, LINE 19 VALLEY VIEW'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: INCOME FROM COLORADO HOSPITAL ASSOCIATION TRUST -108,269. FORM 990, PART XII, LINE 2C: NO CHANGE FROM PRIOR YEAR. VALLEY VIEW HOSPITAL FOUNDATION 1906 BLAKE AVE GLENWOOD SPRINGS CO 81601 731664673 FUNDRAISING CO 501(C)(3) LINE 11A, I N/A 0 SILT IMAGING CENTER LLC 1906 BLAKE AVENUE GLENWOOD SPRINGS CO 816014227 450534711 IMAGING SERVICES CO N/A RELATED 4382 25621 0 1 0.45000 HEALTHCARE MANAGEMENT LLC PO BOX 2907 GRAND JUNCTION CO 81502 841238904 SELF-PAY RECOVERY SERVICES CO N/A RELATED 192453 559995 0 8679 1 0.07180 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 HEALTHCARE MANAGEMENT LLC S 127285 FMV